Adult Psychotherapy Homework Planner

By Arthur E. Jongsma, Jr.

New and updated assignments and exercises to meet thechanging needs of mental health professionals

The Adult Psychotherapy Homework Planner, Fifth Editionprovides you with an array of ready-to-use, between-sessionassignments designed to fit virtually every therapeutic mode. Thiseasy-to-use sourcebook features:

• 92 ready-to-copy exercises covering the most common issuesencountered by adult clients including such problems as chronicpain, family conflict, and anxiety
• A quick-reference format—the interactive assignments aregrouped by behavioral problems including depression, lowself-esteem, panic, dependency, eating disorders, and phase-of-lifeproblems
• Expert guidance on how and when to make the most efficient useof the exercise
• Assignments cross-referenced to The Complete AdultPsychotherapy Treatment Planner, Fifth Edition—so you canquickly identify the right exercises for a given situation orproblem
• A CD-ROM contains all the exercises in a word-processingformat—allowing you to customize them to suit your and yourclients’ unique styles and needs

• Language: English
• Publisher: Wiley
• Release date: Jan 28, 2014
• ISBN: 9781118836378

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Cover image: © Ryan McVay/Getty Images

Cover design: Wiley

This book is printed on acid-free paper. 1

Copyright © 2014 by Arthur E. Jongsma, Jr. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey

Published simultaneously in Canada

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Library of Congress Cataloging-in-Publication Data:

Jongsma, Arthur E., Jr., 1943-

Adult psychotherapy homework planner / Arthur E. Jongsma, Jr.-Fifth edition.

pages cm

Includes index.

ISBN 978-1-118-07672-9 (pbk.)

ISBN 978-1-118-83625-5 (ebk.)

ISBN 978-1-118-83637-8 (ebk.)

1. Psychotherapy-Planning-Handbooks, manuals, etc. 2. Psychotherapy-Problems, exercises, etc. I. Title.

RC480.5.J664 2014

616.89'14-dc23

2013027950

To Dave and Lorrie Vander Ark, whose friendship has enriched our lives and whose support is more reliable than a fine timepiece

PRACTICEPLANNERS® SERIES PREFACE

Accountability is an important dimension of the practice of psychotherapy. Treatment programs, public agencies, clinics, and practitioners must justify and document their treatment plans to outside review entities in order to be reimbursed for services. The books and software in the PracticePlanners® series are designed to help practitioners fulfill these documentation requirements efficiently and professionally.

The PracticePlanners® series includes a wide array of treatment planning books including not only the original Complete Adult Psychotherapy Treatment Planner, Child Psychotherapy Treatment Planner, and Adolescent Psychotherapy Treatment Planner, all now in their fifth editions, but also Treatment Planners targeted to specialty areas of practice, including:

Addictions

Co-occurring disorders

Behavioral medicine

College students

Couples therapy

Crisis counseling

Early childhood education

Employee assistance

Family therapy

Gays and lesbians

Group therapy

Juvenile justice and residential care

Mental retardation and developmental disability

Neuropsychology

Older adults

Parenting skills

Pastoral counseling

Personality disorders

Probation and parole

Psychopharmacology

Rehabilitation psychology

School counseling and school social work

Severe and persistent mental illness

Sexual abuse victims and offenders

Social work and human services

Special education

Speech-Language pathology

Suicide and homicide risk assessment

Veterans and active duty military

Women's issues

In addition, there are three branches of companion books that can be used in conjunction with the Treatment Planners, or on their own:

Progress Notes Planners provide a menu of progress statements that elaborate on the client's symptom presentation and the provider's therapeutic intervention. Each Progress Notes Planner statement is directly integrated with the behavioral definitions and therapeutic interventions from its companion Treatment Planner.

Homework Planners include homework assignments designed around each presenting problem (such as anxiety, depression, substance use, anger control problems, eating disorders, or panic disorder) that is the focus of a chapter in its corresponding Treatment Planner.

Client Education Handout Planners provide brochures and handouts to help educate and inform clients on presenting problems and mental health issues, as well as life skills techniques. The handouts are included on CD-ROMs for easy printing from your computer and are ideal for use in waiting rooms, in presentations, as newsletters, or as information for clients struggling with mental illness issues. The topics covered by these handouts correspond to the presenting problems in the Treatment Planners.

Adjunctive books, such as The Psychotherapy Documentation Primer and The Clinical Documentation Sourcebook, contain forms and resources to aid the clinician in mental health practice management.

The goal of our series is to provide practitioners with the resources they need in order to provide high quality care in the era of accountability. To put it simply: We seek to help you spend more time on patients, and less time on paperwork.

Arthur E. Jongsma, jr.

Grand Rapids, Michigan

ACKNOWLEDGMENTS

Although only my name appears as the author of this book, the product is the result of the combined efforts of many people. I first would like to acknowledge the contribution of my coauthors on several other books, William McInnis and Mark Peterson. They assisted heavily in the rewrite of this edition of the Adult Psychotherapy Homework Planner. They also both previously gave permission for me to borrow and adapt some of the homework exercises we had collaborated on in writing the Adolescent Psychotherapy Homework Planner. Several of the assignments in this book have been adapted to the adult focus group from their original creation for the adolescent client. Thank you, Bill and Mark.

I would also like to thank Jim Finley and Brenda Lenz for giving their permission to me to adapt two of their assignments from their Addiction Treatment Homework Planner for placement in the Substance Use section of this book.

I am grateful to Sue Rhoda, who was so efficient at transcribing this manuscript in a very timely and professional manner.

My support staff at John Wiley & Sons, Marquita Flemming, Peggy Alexander, Sweta Gupta, and Judi Knott, continues to move the PracticePlanners® project forward with enthusiasm and professional dedication. Thank you, all.

Finally, my personal support system is grounded in my wife, Judy, who makes me feel important even when I am not, and my children and grandchildren, who consistently show interest in my work. Thank you, family.

A. E. J.

INTRODUCTION

More and more therapists are assigning homework to their clients. Not only have short-term therapy models endorsed this practice, but the benefits are being recognized by many traditional therapists as well.

WHY HOMEWORK?

Assigning homework to psychotherapy clients is beneficial for several reasons. With the advent of managed care, which often requires shorter and fewer treatment sessions, therapists assign between-session homework to help maximize the effectiveness of briefer treatment. Homework is an extension of the treatment process, provides continuity, and allows the client to work between sessions on issues that are the focus of therapy. Homework is also a tool for more fully engaging the client in the treatment process. Assignments place more responsibility on the client to resolve his or her presenting problems, counteracting the expectations that some clients may experience—that it is the therapist alone who can cure him or her. For some, it even may bring a sense of self-empowerment.

Another added benefit of homework is that these assignments give the client the opportunity to implement and evaluate insights or coping behaviors that have been discussed in therapy sessions. Practice often heightens awareness of various issues. Furthermore, homework increases the expectation for the client to follow through with making changes rather than just talking about change. Exercises require participation, which creates a sense that the client is taking active steps toward change. Homework allows the client to try new behaviors, bringing these experiences back to the next session for processing. Modifications can then be made to the client's thoughts, feelings, or behaviors as the homework is processed in the therapy session.

Occasionally treatment processes can become vague and abstract. By adding focus and structure, homework assignments can reenergize treatment. Moreover, homework can increase the client's motivation to change as it provides something specific to work on. Additionally, homework increases the involvement of family members and significant others in the client's treatment by using assignments that call for their participation. It promotes more efficient treatment by encouraging the client to actively develop insights, positive self-talk, and coping behaviors between therapy sessions. Consequently, many clients express increased satisfaction with the treatment process when homework is given. They are empowered by doing something active that facilitates the change process, and it reinforces their sense of control over the problem. All of these advantages have made the assignment of therapeutic homework increasingly prevalent.

HOW TO USE THIS HOMEWORK PLANNER

Creating homework assignments and developing the printed forms for recording responses is a time-consuming process. This Adult Psychotherapy Homework Planner, Fifth Edition, follows the lead of psychotherapeutic interventions suggested in The Complete Adult Psychotherapy Treatment Planner, Fifth Edition (Jongsma, Peterson, and Bruce, 2014) and provides a menu of homework assignments that can easily be photocopied. In addition to the printed format, the assignments in this Planner are provided on a CD-ROM to allow the therapist to access them on a word processor and print them out as is or easily customize them to suit the client's individual needs and/or the therapist's style.

The assignments are grouped under presenting problems that are typical of those found in an adult population. These presenting problems are cross-referenced to every presenting problem found in The Complete Adult Psychotherapy Treatment Planner. Although these assignments were created with a specific presenting problem in mind, don't feel locked in by a single problem-oriented chapter when searching for an appropriate assignment. Included with each exercise is a cross-referenced list of suggested presenting problems for which the assignment may be appropriate and useful called Additional Problems for Which This Exercise May Be Most Useful. This cross-referenced list can assist you in applying the assignments to other situations that may be relevant to your client's particular presenting problem.

A broader cross-referenced list of assignments is found in Appendix A, Alternate Assignments for Presenting Problems. Review this appendix to find relevant assignments beyond the one, two, three, or four exercises found in any specific presenting problem chapter. For example, under the heading of Unipolar Depression in the appendix you will find 27 alternative assignments originally created for other presenting problems but relevant and easily adapted for use with a client struggling with depression issues. In this appendix, with every presenting problem are listed relevant additional assignments from throughout the book. Remember, each assignment is available on the CD-ROM at the back of the book and, therefore, can be quickly edited for use with a specific client. This modified assignment can be saved on your computer's hard disk for repeated later use.

ABOUT THE ASSIGNMENTS

Therapists may introduce the homework assignment with varying degrees of detail and client preparation. Recommendations regarding this preparation and post-exercise discussion are made on the title page of each assignment under the heading Suggestions for Processing This Exercise with the Client.

Clinical judgment must be used to choose the homework assignments that focus on relevant issues for the client. The title page of each assignment contains a section on Goals of the Exercise to guide you in your selection of relevant homework for your client.

CARRYING OUT THE ASSIGNMENT

It is recommended that you review the entire book to familiarize yourself with the broad nature of the type and focus of the various homework exercises. Select a specific assignment from a chapter titled with your client's presenting problem or from the alternative list in the appendix and then review the list of homework goals. Assigning therapy homework is just a beginning step in the therapy treatment process. Carrying out the assignment requires a follow-up exploration of the impact of the assignment on the client's thoughts, feelings, and behavior. What are the results? Was this assignment useful to the client? Can it be redesigned or altered for better results? Examine and search for new and creative ways to actively engage your client in participating in this homework process.

SECTION 1

ANGER CONTROL PROBLEMS

Therapist's Overview

ALTERNATIVES TO DESTRUCTIVE ANGER

GOALS OF THE EXERCISE

1. Increase awareness of how anger is expressed destructively.

2. Decrease the number, intensity, and duration of angry outbursts while increasing the use of new skills for managing anger.

3. Become capable of handling angry feelings in constructive ways that enhance daily functioning.

ADDITIONAL PROBLEMS FOR WHICH THIS EXERCISE MAY BE MOST USEFUL

Antisocial Behavior

Attention Deficit Disorder (ADD)—Adult

Borderline Personality

Family Conflict

Posttraumatic Stress Disorder (PTSD)

SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH THE CLIENT

Clients often feel they responded to a frustrating situation in the only way possible. They fail to realize that they have choices and control over their behavior. You may want to review the alternatives to rage listed in the first section of the assignment to help the client understand the alternatives he/she could apply when dealing with frustration or anger. Review the client's journal material and suggest additional constructive ways to respond to frustrating or hurtful situations that prompt his/her mismanaged anger.

EXERCISE 1.A: ALTERNATIVES TO DESTRUCTIVE ANGER

Destructive anger can take many forms. Anger can be expressed in rage that is out of control, either verbally or physically. We also can express anger by snapping at someone or being unkindly critical. A third form that anger may take is that of cold, icy withdrawal that punishes others by shutting them out, shunning them, or refusing to acknowledge their attempts to relate to us. All of these reactions and many more can be destructive to the relationship and to our own feelings of self-esteem. Destructive expressions of anger often generate later feelings of guilt and shame.

This exercise is designed to briefly identify some constructive alternatives to destructive anger by giving a brief description of the positive alternative. The goal is for you to consider these alternatives as you seek to replace destructive anger with more constructive behaviors. You will be asked to keep a journal of situations in your daily life that provoked anger and then note how one or more of these constructive alternatives may have been applied to the situations.

CONSTRUCTIVE ALTERNATIVES

A. Assertiveness: Speaking forthrightly in a manner that is very respectful of the other person's needs and rights and does not attack anyone so as to make him/her defensive.

B. Tune Out/Cool Down: Recognize that the situation has become volatile and nonproductive and suggest withdrawal from the situation to give each party a chance to cool down and collect his/her thoughts and regain personal control.

C. Relaxation: Learn and implement relaxation skills to reduce stress and tension through the use of words that cue relaxation, deep breathing that releases tension, imagining relaxing scenes, or deep muscle relaxation procedures.

D. Diversion: When anger is felt to be building, find diversionary activities that stop the buildup and focus the mind on more enjoyable experiences.

E. Physical Exercise: When anger and tension levels rise, physical exercise can be a wonderful way to release tension and expel energy as an alternative to losing control or exploding in rage.

F. Problem-Solving Skills: Identify or clarify the problem, brainstorm possible solutions, review the pros and cons of each alternative solution, select the best alternative for implementation, evaluate the outcome as to mutual satisfaction, and finally, adjust the solution if necessary to increase mutual satisfaction.

G. Self-Talk: Take time to talk to yourself in calming, reasoned, and constructive sentences that move you toward anger control and away from hurtful expressions of anger.

H. "I" Messages: Speak to the target of your anger, describing your feelings and needs rather than attacking, labeling, or describing the other person's behavior, motivations, or goals. Begin your sentences with I feel ... or I need ... .

I. Other: Describe your own or your counselor's alternative to rage.____

APPLICATION TO DAILY LIFE

In the columns that follow, describe the date and time, the situation that prompted the angry response, the destructive response, and the alternative constructive response that might have been used. In the final row, instead of writing a full description of the alternative, you may simply enter the alphabetical indicator of the constructive alternative, A through I.

(NOTE: Please make additional copies of the next page for later entries.)

Therapist's Overview

ANGER JOURNAL

GOALS OF THE EXERCISE

1. Develop an awareness of current angry behaviors, clarifying origins of and alternatives to aggressive anger.

2. Keep a daily journal of persons, situations, and other triggers of anger; record thoughts, feelings, and actions taken.

3. Decrease the number, intensity, and duration of angry outbursts while increasing the use of new skills for managing anger.

ADDITIONAL PROBLEMS FOR WHICH THIS EXERCISE MAY BE MOST USEFUL

Antisocial Behavior

Borderline Personality

Family Conflict

Posttraumatic Stress Disorder (PTSD)

SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH THE CLIENT

Some clients deny the degree of anger they feel and express. Other clients may be aware of feelings of anger but need help in understanding the contributing factors and causes for their anger. As you process the journal entries with clients, help them clarify and pinpoint these contributing factors and the causes for their anger. Often the causes for the anger are not those that are initially identified, but lie beneath the surface and can be discovered with some patient processing. Finally, it is helpful to press the client toward describing positive alternative behaviors that could have replaced the maladaptive anger responses that were selected in the heat of the moment. Positive alternatives may include things like assertiveness, time-out, problem solving, I messages, or self-talk.

EXERCISE 1.B: ANGER JOURNAL

To make you more aware of your angry feelings, the circumstances surrounding them, the target of them, the causes for them, and how they were shown, you are being asked to keep an anger journal. This journal will help you record the when, what, who, why, and how of the angry feelings as well as allow you to give some thought to what alternative emotional, behavioral, or cognitive reaction you might have had to the situation. Be as honest as you can be with yourself about your angry feelings, trying not to discount them, excuse them, or